Embattled Minister John Halligan is refusing to budge on his position that a clinical review of cardiac services in Waterford is "flawed" as his future in Government hangs in the balance.

The Independent TD remained bullish in his view that a second catherisation lab is necessary at University Hospital Waterford, despite calls from within his own Independent Alliance that the matter be resolved.

Minister Katherine Zappone: ‘We must ensure stability’. Pic Tom Burke

Last night Mr Halligan claimed that a HSE document demonstrates "gross interference" with the review into cardiac services at the hospital.

It recommends additional opening hours for the existing lab, more staff and additional equipment.

Crucially, it states that a second cath lab is not justified and Mr Harris said he accepts this finding. But Mr Halligan was still in Government last night, putting off a decision on whether or not he'll stay pending a study by doctors in Waterford of Dr Herity's report.

Last night RTÉ's 'Prime Time' revealed details of a briefing note that was prepared for the review's highly-respected author, Dr Herity.

The note, prepared by the HSE's Acute Hospital Policy Unit 3, referred to the "growing public and political pressure in the Waterford region to build and staff an additional cath lab at the hospital".

But the note continued with the view that providing additional facilities "in a geographical area which does not have the population base to justify such a service, would be wasteful of very limited resources".

It added: "Such a unit might struggle to achieve the levels of activity essential to maintain operator and unit competency, potentially compromising patient safety. Staffing an extended service might also represent a challenge."

The note was dated May 27, shortly after Dr Herity was commissioned for the review.

Last night Mr Halligan claimed that the HSE document demonstrates "gross interference" with the review.

And earlier yesterday Mr Halligan clashed with a number of his Government colleagues over the airwaves.

Formality

He claimed on WLR FM that Finance Minister Michael Noonan told him the clinical review of cardiac services was "only a formality" and that the lab "will be delivered".

He also claimed that Minister Simon Coveney told him that Fine Gael would deliver the lab whether he joined the Government or not.

A spokesman for Mr Noonan said the commitment given to Mr Halligan was that the cath lab would be developed "subject to a favourable recommendation from an independent clinical review".

Mr Coveney said he had told Mr Halligan that Fine Gael was committed to investing in Waterford Hospital "whether John was part of the government or not". But he said any investment had to be based on clinical advice. He said he hopes Mr Halligan stays in Government.

Mr Halligan's departure would mean that the Fine Gael-led minority Government had the bare 58 TDs it needs to ensure it could win Dáil votes with the support of Fianna Fáil.

Meanwhile, other Independent deputies have been approached with the view to replacing Mr Halligan if he does decide to jump ship.

Independent Minister Katherine Zappone - who is not in the Alliance - said that everyone in Government "will do whatever we need in order to ensure the stability".

"Ultimately, if that means we have to look for other people to join us, then that's what we would do," she said.

The Alliance insisted that they remain supportive of Mr Halligan - but that the situation needs to be "resolved".

One possible replacement is Mattie McGrath, who said he'd have to consult with his family and supporters on the matter.

Wicklow TD Stephen Donnelly - who quit the Social Democrats earlier this week - has ruled out joining the Government.

Independent TD Michael Lowry has been voting in support of his former party Fine Gael, despite not being part of the government formation negotiations. He said that his support for the Government will continue and he wouldn't see Mr Halligan leaving as "an opportunity for me to seek additional demands".

The Tipperary TD added: "I think it's hugely important that we have a stable government."

But it has emerged that funding for a so-called 'patient hotel' in Mr Lowry's constituency will not be included in Mr Harris's €40m Winter Initiative budget to be announced today.

It had been reported that Mr Lowry had come to an arrangement with the minister.

A source said the project is still "being considered by officials" but it is "highly unlikely" to be in place for this winter.